1001 Ways to Die

There has got to be a better way to die and surely the patient at the center of our frantic activity couldn’t have wanted this one.  I arrived at his room with a code in progress although, as the patient was still alert, most of the activity involved throwing towels on the floor to soak up the large quantities of ink-colored blood pouring from his mouth, his nose, and the edges of his adult diaper.  The patient was obviously in severe respiratory distress and one of our junior residents who was running the code prepared to intubate, securing the patient’s airway and providing ventilatory support being the first most reasonable step to…well…I don’t know what except that the family wanted everything done even though no power on earth could reverse what was ordained by cruel nature and metastatic cancer.

As the patient opened his eyes for the last time, gaping in horror as he drowned in his own blood, I’m sure he saw gibbering death slouch into the room, leer at the nurses, and settle into the shadows with a smirk on his face to enjoy the end of the show.

Then, as suddenly as turning off a switch the patient was gone which naturally didn’t stop us from ineffectively performing half an hour of violent maneuvers on his body and throwing all manners of potent but useless medications into it before the family, huddling in terror just outside the door, were convinced and asked us to stop.  We slid a breathing tube into his trachea, rammed a  big intravenous line into his femoral artery, crammed him full of fluid, ran electricity through his heart, and bounced him around his stool and blood-soaked bedding; only pausing to look hopefully at the monitor for cardiac activity even though he was glassy-eyed and had that dead look about him.  Our junior resident even optimistically ordered some O-negative blood (which is what you give if you don’t know the blood type) from the blood bank but we weren’t exactly holding our breath for it to arrive from the deep basement labyrinth of the hospital.

If you can believe it, the desperate struggle against failing organs now at an end, he looked better dead than alive but then, as I first saw him crouching on a bedside commode moaning in terror,  I didn’t exactly catch him at his best.

Eternal God Whose great mercy endures forever. Spare me, Your devout but occasionally wayward servant, from this kind of death and grant that I may die peacefully in my bed.

Why People Love Complementary and Alternative Medicine

I had a patient the other day with some very mild conjunctivitis (“pink eye”) which, in otherwise healthy adults is almost always-and I mean the planets align when it’s not-viral or from some other cause that is untreatable except for symptomatic relief.  After checking her visual acuity, verifying that her pupils were normally reactive (to exclude iritis which is a big deal), and even doing a completely unnecessary slit-lamp examination of her cornea I was able to give her the good news that her condition was benign, required nothing but symptomatic relief, and would almost certainly resolve completely in the next one to two weeks without the need for topical antibiotics (which we often prescribe even though the evidence for their effectiveness even in the case of mild bacterial conjunctivitis is less than compelling) but only some mild analgesic eye drops.

The patient balked at the thought of one to two weeks, “Won’t the medications you’re giving me make it heal faster?”

“No,” I explained.  The eye drops just offer relief of symptoms but nothing we can do will shorten the duration of your conjunctivitis. It’s very mild, we don’t really know what’s causing it, and you should be fine.  If it gets worse you can see an ophthalmologist or even come back here.”

“Can’t you give me something to make it heal faster?”

“No,” I explained.  The eye drops will just offer relief of symptoms but nothing we can do will shorten the duration of your conjunctivitis. It’s very mild, we don’t really know what’s causing it, and you should be fine.  If it gets worse you can see an ophthalmologist or even come back here.”

And so it went for five minutes after which, not convinced, the patient allowed that she would be paying a visit to a well known local Wellness Center, a shameless emporium of every form of snake oil I have ever heard of, where no doubt the magician on duty will provide some magical potion or Eastern herb that will miraculously cure her conjunctivitis in from one to two weeks.

And yes, Gentle readers, there are people in our sad and rapidly deteriorating country who will come to the Emergency Department at two in the morning for mild, and I mean mild, “pink eye.”